Electrosurgical medical system and method

ABSTRACT

A medical device system and method provide an RF electrosurgical generator coupled to an electrosurgical electrode via a patient box disposed in close proximity to the patient. An RF signal is delivered from the generator to the patient box where signal power is increased and the RF signal delivered to the electrosurgical electrode. The patient box is coupled to the electrosurgical electrode by a short cable capable of carrying an HV, high frequency 5 MHz signal without leakage. An electrical characteristic associated with the electrosurgical electrode is monitored and a desired RF power output and duty cycle maintained by adjusting DC input voltage applied to an RF amplifier, responsive to the monitoring. The system determines when the electrosurgical cutting electrode has started cutting and switches from a start mode to a run mode having a different RF duty cycle and a reduced RF power output controlled by a servo system.

RELATED APPLICATIONS

This application is a continuation of U.S. application Ser. No.12/229,794, filed Aug. 27, 2008 which is a divisional of U.S.application Ser. No. 11/297,652, filed Dec. 7, 2005, (now U.S. Pat. No.8,133,218) which is related to U.S. application Ser. No. 10/847,699filed May 17, 2004, and U.S. Provisional Application Ser. No. 60/475,747filed Jun. 3, 2003, the contents of each of which are hereby expresslyincorporated by reference as if set forth in their entireties. Thisapplication also is a continuation-in-part of application Ser. No.11/703,861 filed Feb. 8, 2007, which is a divisional of Ser. No.10/658,572 filed Sep. 9, 2003, now U.S. Pat. No. 7,175,618, which is adivisional of Ser. No. 09/752,978 filed Dec. 28, 2000, now U.S. Pat. No.6,620,157, all from which priority is claimed.

FIELD OF THE INVENTION

The present invention relates to an electrosurgical method and systemincluding an electrosurgical generator and an electrosurgical electrode.

BACKGROUND

Typical electrosurgical procedures, such as cutting or cauteryprocedures, are performed with a handheld device which the user canmanipulate and control as the RF energy is delivered to theelectrosurgical, electrode in order to facilitate the creation of thedesired effect at the electrosurgical electrode which performs thecutting or cautery procedure. As disclosed in U.S. patent applicationSer. No. 10/714,126 issued to Marion, et al., it would be advantageousto have an automated method to evaluate effects at the electrode and toautomatically adjust RF characteristics at the electrode based on suchfeedback. Such a feedback procedure is clearly preferred to a methodthat relies upon the user to sense and feel a change in cuttingcharacteristics while cutting with the electrosurgical electrode. Forexample, different tissue impedances and cutting electrode contact areasaffect the voltage and current required to cut and require adjustment tothe RF power supplied to the electrode. To rely on the user's impressionof the cutting quality to adjust cutting parameters would not be themost efficient way to optimize the cutting or cauterizing operation.

Furthermore, starting a cut is a different process than the actualcutting process and can require different control parameters than thecutting operation. Typical electrosurgical generator/electrode systemsdo not distinguish between starting a cut and cutting and do not providedifferent controls for these different modes of operation. It wouldtherefore be advantageous to provide an electrosurgicalelectrode/generator system that does differentiate between the twoaforementioned modes to provide desired control capabilities in each.

Another concern in RF electrosurgical electrode/generator systems is thedifferent cutting characteristics required by different tissue types.For example, certain tissue types require high RF power outputs toefficiently cut the tissue. In particular, some tissue types require ahigh RF output voltage but do not require high average power to sustaincutting. Simply controlling the RF output voltage and current, however,is not sufficient to support all tissue types and combinations of tissuetypes. Further, more custom tailored controls are needed.

Leakage currents, inadvertent currents between an electronic device andearth ground, are a serious concern in RF devices such as an RFelectrosurgical generator/electrode system. It would be desirable toprevent or at least mitigate such leakage currents. Since inadvertentcontact between the patient and earth ground can cause undesirableleakage currents, it would logically be advantageous to provide anelectrosurgical electrode/generator system with leakage path detectioncapabilities.

In summary, it would be desirable to provide an electrosurgicalelectrode/generator system capable of detecting the difference betweencutting mode and a start-to-cut mode and providing separate controls andfeedback systems in each mode. It would further be desirable to providecontrols with novel and efficient telemetry systems that providefeedback and control of the cutting or cauterizing operation based uponmonitoring characteristics at the electrode. It would further bedesirable to mitigate leakage and to detect leakage paths when leakagedoes occur. The present invention addresses these and other needs.

SUMMARY OF THE INVENTION

To address these and other needs and in view of its purposes, theinvention provides a medical device system including an electrosurgicalgenerator and method for operating and controlling the electrosurgicalgenerator to perform operations on a patient.

According to one aspect, RF power is delivered from an electrosurgicalgenerator to an electrosurgical electrode being used on a patient. Themethod and system comprise providing an RF electrosurgical generator ina generator housing and a patient box in a patient box housing, thepatient box housing disposed in close proximity to the patient and thegenerator housing disposed further from the patient than the patient boxhousing. An RF signal with a first RF power is delivered from theelectrosurgical generator to the patient box. RF power of the RF signalis increased in the patient box and the RF signal with an increased RFpower is delivered to the electrosurgical electrode as an RF output. Thepatient box is coupled to the electrosurgical electrode by a cable notgreater than 2 meters long.

According to another aspect, a method and system for controlling anelectrosurgical electrode of a medical device comprise delivering energyfrom an RF generator to an electrosurgical electrode, the RE generatorincluding an RF amplifier; monitoring an electrical characteristicassociated with the electrosurgical electrode; and maintaining a desiredRF power output and a desired RF duty cycle by adjusting DC inputvoltage applied to an output stage of the RF amplifier based on themonitoring.

According to another aspect, a method and system for controlling anelectrosurgical cutting electrode of a medical device provide fordelivering energy from an RF generator to an electrosurgical cuttingelectrode; determining when the electrosurgical cutting electrode hasstarted cutting tissue; and switching the delivering energy from a startmode that provides a relatively high RF power output and a first RF dutycycle, to a run mode having a second RF duty cycle and a reduced RFpower output controlled by a control system servo responsive to thedetermining when cutting has started.

According to another aspect, a method and system for mitigating leakagein an RF electrosurgical generator provide for delivering an RF signalfrom an RF electrosurgical generator to an electrosurgical electrode byway of a patient box. The RF electrosurgical generator includes an RFamplifier. A balanced and symmetrical shielded transmission line couplesthe electrosurgical generator disposed in a first housing to the patientbox disposed in a second, different housing. A common mode choke isincluded in the patient box. The common mode choke includes an outputwinding and a return winding, each winding wound about a ferrite core,the output winding and the return winding spaced apart and in parallelto maintain a desired impedance, the output winding comprising a wirecarrying the RF signal as an output signal and the return windingcomprising a duality of intertwined wires carrying a return signal froma return electrode, each winding having adjacent ribs spaced apart. Acommon mode signal is directed from the RF signal to the common modechoke thereby blocking the common mode signal.

BRIEF DESCRIPTION OF THE DRAWING

The present invention is best understood from the following detaileddescription when read in conjunction with the accompanying drawing. Itis emphasized that, according to common practice, the various featuresof the drawing are not necessarily to scale. On the contrary, thedimensions of the various features are arbitrarily expanded or reducedfor clarity. Like numerals denote like features throughout thespecification and drawing.

FIG. 1 is a schematic view showing the electrosurgicalgenerator/electrode of the invention being used to perform a procedureon a patient;

FIGS. 2A-2C show various embodiments of the electrosurgical electrode ofthe invention;

FIG. 3 is a block diagram of an exemplary electrosurgical generatorsystem of the invention;

FIG. 4 is a block diagram showing input power conditioning and isolationin the electrosurgical generator system of the invention;

FIG. 5 is a block diagram showing the RF amp power supply in theelectrosurgical generator system of the invention;

FIG. 6 is a block diagram showing a B+ modulator in the electrosurgicalgenerator system of the invention;

FIG. 7 is a block diagram of the RF amplifier of the electrosurgicalgenerator system of the invention;

FIG. 8 is an exemplary block diagram of the patient box of theelectrosurgical generator system of the invention;

FIG. 9 is a block diagram of the analog control system of theelectrosurgical generator system of the invention;

FIG. 10 is a block diagram of the digital control system of theelectrosurgical generator system of the invention;

FIG. 11 is a block diagram of the control servo system of theelectrosurgical generator system of the invention;

FIG. 12 is a block diagram of the control logic system of theelectrosurgical generator system of the invention;

FIG. 13 is a block diagram showing power calculation for the RFelectrosurgical generator of the invention;

FIG. 14 is a telemetry block diagram for the RF electrosurgicalgenerator of the invention;

FIG. 15 is a block diagram showing the tissue matching capabilities ofthe RF electrosurgical generator of the invention;

FIG. 16 is a block diagram showing the leakage mitigation system of theRF electrosurgical generator system of the invention; and

FIG. 17 is a block diagram showing leakage path detection capabilitiesof the RF electrosurgical generator of the invention.

DETAILED DESCRIPTION

The present invention provides an electrosurgical electrode/generatorsystem that includes an electrosurgical electrode and an electrosurgicalgenerator (ESG) with a very high reserve power capability. The systemcan carry out cutting and cautery functions and the cautery function isaccomplished with high voltage sine waves rather than waveforms withhigh crest factors. This means that the electrosurgical generator cansustain high output voltage and current simultaneously over time—itspower output is about three times greater than a typical electrosurgicalgenerator in one exemplary embodiment.

FIG. 1 is a schematic diagram of an exemplary system and showselectrosurgical generator 2 being used to perform an operation onpatient 4. The system includes patient box 6 coupled to electrosurgicalgenerator 2. Electrosurgical generator 2 is an RF generator. Two RFoutputs extend from patient box 6: one RF output provided to scalpel orelectrosurgical electrode 8 and one to return electrode 10.

Patient box 6 is located in close proximity to patient 4. In theillustrated embodiment, patient box 6 lies on the operating tableimmediately next to patient 4. In another exemplary embodiment, patientbox 6 may rest between the legs of patient 4. Electrosurgical generator2 is located at a more distant location from patient 4. This arrangementprovides the advantage that a high voltage, HV, high frequency (highMHz) signal can be delivered to patient 4 with minimal loss of RF powerdue to the antenna effect associated with a long wire. An RF signal isprovided from electrosurgical generator 2 to patient box 6 via cable 24.Cable 24 may be a relatively long cable allowing electrosurgicalgenerator 2 to be located at a distance of 10 meters or more frompatient 4. In one embodiment, electrosurgical generator 2 may bedisposed in another room. The RF output delivered from electrosurgicalgenerator 2 to electrosurgical electrode 8 is stepped-up in patient box6 by means of a transformer disposed within patient box 6. In otherwords, the RF power of the RF signal delivered from patient box 6 toelectrosurgical electrode 8 is greater than the RF power of the signaldelivered from electrosurgical generator 2 to patient box 6. In thismanner, a high power signal can be delivered to electrosurgicalelectrode 8 without much loss due to antenna effect because cable 20 isthe only cable that carries the stepped-up high voltage, high frequencyRF signal and cable 20 is relatively short because of the proximitybetween patient box 6 and patient 4. In one embodiment, cable 20 may be2 meters or less, and may preferably be 1 meter or less. Similarly,cable 21 connecting return electrode 10 to patient box 6 may be ofsimilarly short dimension.

This arrangement enables the inventive electrosurgical generator tolimit leakage current even though operating at high operatingfrequencies of about 5 megahertz and providing high output power. In aconventional electrosurgical generator arrangement, there is no patientbox and the output of the electrosurgical generator comes directly froma panel of the generator and connects to the patient and cuttingelectrode via a long paired cable which may be 3 meters long or longer.While this may be usable at low frequencies (0.5 to 2 MHz) it causesleakage currents at high frequencies such as frequencies in the 5 MHzrange. This type of cable connection in conventional technology is notbalanced and provides capacitive and inductive leakage pads andadditionally, the long wire connection provides a large antenna area forradiated leakage. To mitigate against such leakage currents,electrosurgical generator 2 includes a balanced output. The balancedoutput is provided by transformer coupling the RF output from theelectrosurgical generator to the patient box using a shielded balancedtransmission line. RF output is isolated from ground and any leakage toground is identical for both output and return conductors. Since thesetwo signals have opposite phases, the leakage currents cancel. This willbe discussed in further detail below.

FIGS. 2A-2C are perspective views showing various exemplary embodimentsof scalpel/electrosurgical electrode 8. Electrosurgical electrode 8includes hand piece or housing 12, input power line 14, cutting probe 16and mechanical controls 18. Cutting probe 16 is the electrode. Wheninitiating a cut, a plasma is formed in vicinity 19 of cutting probe 16.

FIGS. 2A-2C show different exemplary configurations of cutting probe 16.Other configurations may be used as well. Each of the exemplary cuttingelectrodes shown in FIGS. 2A-2C is exemplary and the cutting probe 16,housing 12 and mechanical controls 18 may take on other shapes andlocations in other exemplary embodiments.

One aspect of the invention provides a method and system for controllingthe electrosurgical electrode of a medical device by delivering energyfrom the RF generator to the electrosurgical electrode. The RF generatorincludes an RF amplifier. An electrical characteristic associated withthe electrosurgical electrode is monitored. A desired RF output leveland a desired RF duty cycle is maintained by adjusting DC input voltageapplied to an output stage of the RF amplifier based on monitoring theelectrical characteristic.

Another aspect of the method and system of the invention is leakagecurrent detection. An RF signal is delivered from an RF electrosurgicalgenerator to an electrosurgical electrode by way of a patient box, thepatient box and the RF electrosurgical generator disposed in separatehousings such as shown in FIG. 1. A leakage current is detected byinducing a test signal in the patient box. This is done by directing theRF signal through an RF transformer in the patient box, coupling aseries of two capacitors between ground and a center tap of a winding inthe RF transformer, and inducing the test signal onto RF output leads ofthe patient box by passing the RF signal through a common modetransformer. The test signal has a frequency of about 500 kilohertz.According to one aspect, a balanced and symmetrical shieldedtransmission line couples the electrosurgical generator to the patientbox by way of the transformer. The patient box may include a common modechoke. The common mode choke includes an output winding and a returnwinding, each wound about a ferrite core. The output winding and returnwinding are spaced apart and in parallel to maintain a desiredimpedance. The output winding is formed of a wire carrying the RF signaland the return winding includes intertwined wires. Each winding includesspaced-apart adjacent ribs. A common mode signal from the RF signal isdirected to the common mode choke thereby blocking the common modesignal while allowing the output signal to be applied substantiallyunaltered to a patient.

The electrosurgical cutting electrode may be controlled in differentoperational modes. Energy is delivered from an RF generator to anelectrosurgical cutting electrode. It is determined when theelectrosurgical electrode has started cutting tissue and, when this isdetermined, the energy delivery system is switched from a start modethat provides a relatively high RF power output and a first RF dutycycle, to a run mode having a second RF duty cycle and a reduced RFpower output that is controlled by a servo system. A matching unit isused to control the system during the start mode.

Further details of these aspects are discussed in reference to thefollowing figures.

FIG. 3 shows an overall block diagram of the system and FIGS. 4-10 areblock diagrams showing further details of the components represented byblocks in the block diagram of FIG. 3. FIG. 3 shows electrosurgicalgenerator 100, patient box 102, RF outputs 104 and 106 and line-in 108.Electrosurgical generator 100 is an RF generator and is coupled topatient box 102 by lines 110. RF output 106 is supplied to theelectrosurgical electrode (not shown) and RF output 104 is supplied to areturn electrode (not shown). Within electrosurgical generator 100 are:Input Power Conditioning and Isolation System 122; RF Amp Power Supply112; B+ Modulator 114; RF Amplifier 116; Analog Control System 118; andDigital Control System 120. FIG. 4 is a block diagram showing furtherdetails of Input Power Conditioning and Isolation System 122. FIG. 5 isa block diagram showing further details of RF Amp Power Supply 112. FIG.6 is a block diagram showing further details of B+ Modulator 114. FIG. 7is a block diagram showing further details of RF Amplifier 116. FIG. 8is a block diagram showing further details of Patient Box 102. FIG. 9 isa block diagram showing further details of Analog Control System 118.FIG. 10 is a block diagram showing further details of Digital ControlSystem 120. Like labels denote like features throughout the drawings andcontrol lines Control 1-Control 7 indicate connections and controlsbetween the sub-systems as appear in FIG. 3 and in FIGS. 4-10. As shownin FIG. 1, electrosurgical generator 100 and patient box 102 of FIG. 3,are disposed in separate housings (represented by features 2 and 6,respectively, of FIG. 1).

The electrosurgical generator/electrode system may be used to performvarious cutting/cauterizing operations on various patients and on tissuewith various characteristics. The control system of the inventionaccommodates different characteristics of the material being cut anddifferent modes of operation of the electrosurgical electrode. Thescalpel/cutting/electrosurgical electrode will hereinafter be referredto simply as the electrode. When cutting tissue of a patient, differenttissue impedances and different electrode contact areas affect thevoltage and current required to cut tissue. Moreover, starting a cut isa different process than cutting and advantageously utilizes differentcontrol parameters. Whereas a typical ESG does not distinguish between astart mode for starting a cut and a cut mode during which cutting takesplace, and has no controls for these different modes of operation, theelectrosurgical generator of the invention differentiates between suchoperational modes and supports substantial flexibility and programmaticcontrol over the different requirements associated with the differentmodes. As shown in FIG. 3, the output of the inventive electrosurgicalelectrode is controlled by adjusting the DC voltage applied to theoutput stage of RF amplifier 116 (Control 5). This sets the outputvoltage of the electrosurgical generator when a high impedance load isconnected. Lower impedance loads cause the RF output voltage to drop dueto the internal impedance of the RF amplifier circuitry. This is truefor any amplifier type and is typical for an electrosurgical generator.To keep the RF output constant with different output loads, a servosystem is used to adjust the applied DC voltage to maintain the RFoutput during run or cut mode but not during start-to-cut, i.e., startupmode. In one exemplary embodiment, the RF output, may be maintained at aconstant level. This portion of the control system is the voltage servo,and represents a departure from conventional electrosurgical generatortechnology.

Different tissue types have different impedances and it has been foundthat high impedance tissue requires higher cutting voltages than lowimpedance tissues, however, applying excessive voltage for a giventissue type results in arcing and sputtering at the cutting electrode.Automatically limiting the RF output current reduces the RF outputvoltage when low impedance tissue is encountered by the cuttingelectrode. To account for these effects, the RF electrosurgicalgenerator of the invention provides a current servo system which servesto adjust the DC input voltage to the RF amplifier to maintain thedesired RF output current and duty cycle. Tissue impedance is measuredindirectly by measuring the voltage, current, and the phase anglebetween the voltage and current signals in the RF output.

Some tissue types require a high RF output voltage but do not requirehigh average power to sustain cutting. Simply controlling the RF outputvoltage and current, however, is not sufficient to support all tissuetypes and combinations of tissue types. The electrosurgical generatoraddresses this problem by controlling the RF output duty cycle. Thisparameter of the RF electrosurgical generator is user selectable overthe range of about 15% to 40%. Changes in the RF output duty cycle areperceived as physical drag at cutting electrode. Higher duty cycles haveless drag and allow for more rapid cutting than lower duty cycles. Assuch, this control of the duty cycle may be considered and referred toas “cut speed”. The duty cycle may be defined as the ratio of the pulseduration to the pulse period. The RF electrosurgical generator alsoprovides a coagulate, or simply “coag” mode which makes use of an evenshorter 10% duty cycle which does not deliver sufficient power foreffective cutting in one exemplary embodiment.

The electrosurgical generator of the invention differentiates between astart mode and cut mode. During active cutting, the cutting probe 16 ofthe electrosurgical electrode is surrounded by a plasma, at location 19proximate cutting probe 16 as referred to in FIGS. 2A-2C. Prior to thestart of cutting, the electrode, i.e. cutting probe 16, is in directcontact with tissue and the impedance is considerably lower than duringcutting. Initiating a cut while in direct contact with tissue requiresmuch more power than required during a cutting operation, i.e. itrequires much more power than to sustain a cutting operation. Theinventive RF electrosurgical generator has a user selectable start modewhich selects different control parameters than cutting controlparameters. In start mode, typical control settings would include alower RF voltage output and a much higher current. Additionally, whenstart condition is detected, a matching network is inserted into the RFfeed to improve the ability of the RF electrosurgical generator todeliver power to the substantially different impedance present duringstart. This network is switched out once successful startup has beendetected and the generator moves to cutting mode. During cutting mode,the matching network is not used: rather; a server control system isused. In one exemplary embodiment, startup mode may include apreprogrammed duty cycle that is higher than would be used duringcutting, for example in the 50-100% range. As above, during cuttingmode, the selectable duty cycle may advantageously be within the rangeof 15% to 40%.

The electrosurgical generator includes a safety system. The safetysystem detects when the control system demands more power than the RFamplifier can deliver. This may indicate a fault in the control systemor a problem with calibration. The control system supports anothercontrol parameter: RMS (root mean squared) DC input current to the RFamplifier. Peak current is not a reliable indicator of output powerbecause it is dependent on the output duty cycle. Short duty cycles havea disproportionately high peak current. The DC current servo limits theRF output voltage to keep the DC current below the maximum set point.This allows short term maximum RF output power to any low impedanceload. In one embodiment, the control system monitors DC currentindependent of the other control modes selected. In one exemplaryembodiment, the control system only comes into effect when the RFamplifier is at its maximum limit, although lower set points may be usedin other exemplary embodiments.

The control system of the invention functions to keep the totalintegrated power output of the electrosurgical generator below aprescribed maximum power such as 400 Watt-seconds in an exemplaryembodiment. A separate safety monitoring circuit is provided whichprevents the 400 Watt-second limit from being exceeded, however thecontrol system itself is designed to limit power output. The full power,e.g. 1200 Watt output power and/or 100% duty cycle, may be madeavailable in start mode only. Other maximum power values may be used inother exemplary embodiments. Applicants have determined, however, thatin various exemplary embodiments, lower output duty cycles such as a 50%output duty cycle is as effective in starting as a 100% duty cycle. Assuch, the average power output may alternatively be reduced tohalf-maximum power, e.g., 600 Watts. Instantaneous power, e.g. 400Watt-seconds, may be maintained as this parameter critically controlscutting operations. To limit the total power output joint start mode,the start mode may be time-limited. For example, the start mode may belimited to 600 milliseconds in one exemplary embodiment.

The electrosurgical generator of the invention detects when a cut hasstarted and switches from start mode to cut mode when such is detected.A DC voltage appears across the RF outputs (cutting electrode and returnelectrode) as a result of plasma forming on the cutting electrode. ThisDC voltage signal is used to determine how effectively anelectrosurgical generator is cutting, as well as when the cut hasstarted. The inventive electrosurgical generator includes a controlsystem that monitors the level and polarity of this DC voltage signaland determines when cutting has started. The control system thenswitches modes when cutting has started. The DC voltage system may bereferred to as a “cut quality signal”. In other exemplary embodiments,the switch between modes may be made responsive to the associated tissueimpedance change when cutting starts. According to this exemplaryembodiment, the voltage and current outputs are monitored and theimpedance calculated. The afore-described cut quality signal is used bythe control system. Once the electrosurgical generator/electrode systemhas entered cut mode, the control system uses a servo system to maintainthe cut quality signal above a minimum level. The minimum level may bepre-selected. In this manner, the electrosurgical generator may use thelowest amount of power required to continue cutting. This, in turn,results in the least amount of tissue damage due to heating oroverheating. The cut quality signal can become quite large in sometissue types. To avoid this from causing the RF output voltage to dropto such a low level that cutting would stop at the next tissue boundary,the electrosurgical generator of the present invention provides aminimum voltage output limit while operating in cut quality servo mode,described above. The minimum RF voltage output is set such that theplasma never quenches.

As described above, the configuration of the inventive electrosurgicalgenerator enables a system that provides a very high power output. Theextra power is put to use via a complex control system that works withvarious, different tissue types and the electrosurgical generator has astart mode that advantageously makes full use of the output power. Theelectrosurgical generator can detect when tissue cutting has started andswitch the control system from a start up mode that uses a matchingnetwork to a run mode controlled by a servo system.

Each of the control inputs or telemetry used by the electrosurgicalgenerator, for example RF voltage, RF current, cut quality signal, etc.,are available for use by an external system. These signals are intendedfor use for expanding internal functionality such as tissue matching aswill be discussed, or to provide feedback to a further surgical device.The telemetry signals can be galvanically isolated to facilitatemonitoring operation when the electrosurgical generator/electrode systemis coupled to a patient.

The electrosurgical generator/electrode system of the invention iscompatible with robotics. When a robotic system is utilized, it does nothave the same tactile feedback that a human operator has. In thisembodiment, several of the telemetry signals may be used directly orfurther processed to determine how the system is performing. In oneembodiment, the telemetry signals may provide detail as to the kind oftissue being cut, and the transition from one tissue type to another,for example from healthy tissue to cancerous tissue. This informationmay be displayed or fed back into the robotic system. For example, whencancerous tissue is being removed, it is important that immediatelyadjacent healthy tissue is also removed as a safeguard.

The electrosurgical generator of the invention provides a tissueimpedance matching feature such that the output impedance of the RFamplifier matches the load impedance of the tissue to enable thetransfer of maximum power to a load. The primary impedance match in thesystem is accomplished in the patient box RF transformer. Applicantshave found that breast tissue, for example, has an impedance of about450 ohms when cutting and have also found that a class D amplifier witha 350 ohm transformer can effectively match the detected tissueimpedance. Impedance matching may alternatively be accomplished withreactive components. In start mode, when the system expects to startinto low impedance tissue, a matching network is switched inline withthe RF amplifier to provide a reactive match to the expected tissueimpedance. This enables the electrosurgical generator to transfer moreof the RF output power to the tissue, allowing an efficient start. Oncetissue starting has been accomplished, the matching network is switchedout of circuit. The matching network matches average expected tissueimpedances. Output voltage, current and phase is measured and actualtissue impedance calculated therefrom. Once the tissue impedance isknown, an exact matching network is selected either by selecting from anumber of fixed networks or by using variable networks that are tuned asrequired. The electrosurgical generator/electrode system measures RFparameters voltage, current and phase at two different locations in thesystem: at the point of load in the patient box and at the output of anRF combiner as are shown in FIG. 15. The matching network isadvantageously located at the output of the RF combiner.

Leakage is mitigated in the RF electrosurgical generator/electrodesystem as described above. Leakage currents are currents that can returnto earth ground from the output of the device and include a galvanicpath to ground and capacitive, inductive and radiated pads to ground athigh frequencies. The magnitude of the current flowing in these pads isdirectly proportional to the operating frequency and output power. Sincethe two RF output signals have opposite phases as described above, theleakage currents largely cancel. Any unbalanced signal results in acommon mode signal which would be the only leakage current. The patientbox employs a common mode choke in series with the output to furtherreduce RF leakage. This choke, shown in FIG. 16, and discussed infra.,does not affect the differential output applied to the patient, butprovides a high impedance path to any leakage current.

The design of the common mode choke is critical to prevent theintroduction of shunt capacitance to the output circuit which results insignificant impedance mismatch to the load being applied to the patient.The common mode choke includes an output winding and a return winding,each wound about a ferrite core. The output winding and return windingare spaced apart and in parallel to maintain the desired impedance. Theoutput winding includes a wire carrying the outgoing RF signal and thereturn winding includes a duality of intertwined wires. Each windingincludes the adjacent ribs spaced apart. The winding is kept symmetricalto maximize a balanced nature of the choke and the slotted rectangularferrites are coupled to form the core. Input and output connections arephysically separated to reduce the coupling from input to output. Thephysical design of the patient box that contains the common mode chokeis also balanced as any asymmetry in the patient box induces a commonmode path that contributes to leakage. The patient box includes the mainRF power connection and several control and telemetry signals and all ofthe components of the main RF power path are physically arranged assymmetrically as possible which equalizes the capacitive coupling to thepatient box enclosure which is grounded. The telemetry signals areconnected via a balanced circuit. To further mitigate leakage, the pushbutton interface for hand piece cut and coags control has extremeisolation to prevent further leakage. The section of this circuit thatconnects to the hand piece is battery powered to provide galvanicisolation from the rest of the patient box circuitry. The cut and coagsignals are transmitted via fiber optic cable, as conventional opticalisolation integrated circuits have been found to include too muchcapacitive coupling to allow for their use.

The system of the invention also provides for leakage path detection.The cutting and return electrodes connected to the patient box arewidely separated during operation. For example, the cutting electrodemay be used to cut cancerous breast tissue while the return electrode isin contact with the patient's buttocks. Other arrangements may be usedin other exemplary embodiments and the cutting electrode may be used tooperate on any part of the patient's anatomy. The electrodes cause asignificant amount of common mode current to flow which exposes thepatient to the risk of leakage by contacting a grounded piece ofequipment. One way to reduce such potential leakage currents is toreduce the output level of the electrosurgical generator. The inventionalso provides an active monitoring circuit to detect a leakage currentpath. When the circuit detects a leakage path, it disables and turns offthe output of the electrosurgical generator and sounds an alarm.

The leakage path detection system of the invention uses a test frequencymuch lower than the frequency of the output signal, e.g. 5 megahertz andmuch higher than the main frequency, e.g. 60 Hz. In one exemplaryembodiment, the test frequency may be 500 KHz, but other frequencies maybe used in other exemplary embodiments. The leakage path detectioncircuit monitors the leakage path to ground. In order to accomplishthis, the detection circuit must be referenced to ground without causinga leakage path. The inventive system accomplishes this by connecting asmall value capacitor from the center tap of the RF output transformerto ground. In one exemplary embodiment, the capacitor may have a 50picofarad capacitance, but other capacitance values may be used in otherexemplary embodiments. Since this connection is made at the center tap,it does not unbalance the RF output and does not contribute significantleakage current.

The test signal is induced onto the output of the patient box using atransformer. The secondary winding of the transformer is a balancedwinding of both RF output leads. It may be similar to a common modechoke. When either of the two RF output leads, i.e. the cuttingelectrode and return electrode comes in contact with ground, currentflows in the leakage path circuit which is detected by a pair of currenttransformers. Two transformers are used to form a redundant circuit,eliminating a possible single point failure. Additionally, the drivesignal is continuously monitored for proper operation. This eliminatesthe drive signal as a possible source of failure. The leakage detectiondrive is inactive until RF output is requested and delivered. When thisoccurs, the leakage detection drive circuit is activated and the circuittests for the presence of a leakage path. If no leakage path isdetected, the RF output is enabled. The leakage detection circuitremains active while RF output is active, providing detection while theelectrosurgical generator is in use. When the circuit does detect aleakage path, the RF output is turned off and an alarm optionallysounded.

FIGS. 11-17 are schematic block diagrams illustrating various systems ofthe invention. Each is intended to be exemplary and not restrictive ofthe invention.

Referring to the control system servo block diagram in FIG. 11, theelectrosurgical generator has several functional blocks that make up thecontrol system. The exemplary servo block is one of these functionalblocks. The servo block in its simplest form makes an output controlvoltage based on a setpoint and a feed back signal. In the case of theelectrosurgical generator there is one main servo circuit to control theRF voltage output level. This circuit has additional limit inputs thatcan be used to reduce the RF voltage based on different parameters. Thesetpoints for voltage, current and cut quality are selected by digitallogic from a preset array of 4 setpoints. The B+Current and RF Floorsetpoints have only one setting each.

The main servo feedback signal is the RF output voltage as sensed by thepatient box. In general this signal and its setpoint are used to set themaximum RF output voltage required. In many instances operating theelectrosurgical generator at the maximum RF output voltage is notpossible due to circuit limitations, or not required for the type oftissue being cut. Circuit limitations are for the most part related tothe maximum power capability of the RF power amplifier and the maximumpower capability of the RF power supply. Since the maximum RF outputvoltage and power supply voltage are both known, power can be controlledby limiting either the RF output current, or the power supply current.Proper selection of the control setpoints allows the electrosurgicalgenerator to operate in a controlled manner at the maximum RF outputpower.

The RF Voltage and RF Current output of the Patient Box are rectifiedand detected by the Analog Control PCB to make pulses proportional tothe voltage and current. The pulses are applied to sample and holdcircuits which may advantageously hold the value constant betweenpulses. This produces a continuously varying signal proportional to theRF voltage and current. Thus the servo circuit works with smoothlyvarying signals so that the RF output is consistent from pulse to pulse.

The power supply current is sensed by the B+Modulator. This currentoutput has a complex wave shape, as the current draw is not continuousdue to the RF output duty cycle. The current output is applied to an RMSvoltage convert on the Analog Control circuit board before it is used asa control input. The RMS value is directly proportional to the outputpower of the power supply.

The cut quality signal is produced by the RF output pulses, but does nothave an RF component. The signal is applied to a sample and hold circuitas described above for the voltage and current. Since the cut qualitysignal can lag behind a change in tissue type, the cut quality signalcould reduce the RF output voltage to the point that cutting might stop.For this reason an RF Voltage output Floor setpoint is used to keep theRF output above a minimum level.

Referring to the Control Logic Block Diagram of FIG. 12, theelectrosurgical generator control logic regulates the operation of theRF amplifiers by selecting the setpoints of the servo controls,selecting the duty cycle, and switching the matching network. Presetcontrol settings may be selected by the user via front panel controlsand foot switches. Operation of the electrosurgical generator is enabledvia foot switch or hand controls. Any detected circuit faults arereported to the control logic as errors that will either inhibitoperation, or turn off the RF output. Turning on the RF output requiresthat several subsystems be enabled. This acts as an interlock preventinga single point failure from producing uncontrolled RF output.

The electrosurgical generator control logic is implemented in 3 CPLDs.The CPLD are electrically reprogrammable and the control functions andtheir interactions can be changed. The description here is of theexemplary illustrated logic configuration of FIG. 12. Otherconfigurations can be utilized to make use of the electrosurgicalgenerator features in different combinations.

The control logic generates the output duty cycle, and selects thepreset servo control set points. The matching network can also be switchin or out of circuit as described supra. The current electrosurgicalgenerator setting allows the selection of eight different Cut dutycycles from 15% to 40% in one exemplary embodiment, as well as enablingstart mode. The Coag duty cycle is fixed at 10% in one exemplaryembodiment. Duty cycle is controlled as “Cut Speed” selected by eitherfront panel control or by foot switch control. Start mode can only beselected from the front panel.

In the electrosurgical generator, start mode is intended to be a high RFoutput power mode coupled with use of a matching network. The controllogic selects the servo presets associated with start mode. Since startmode may be limited to 600 milliseconds of operation in one exemplaryembodiment, more power can be safely allowed than in normal operation.The transition from Start mode to normal operation is triggered by theCut Quality signal exceeding a setpoint. In normal operation thematching network is switched out of the RF output path, and the lowerpower Run servo presets are selected.

There are several safety related signals and systems monitored by thecontrol logic. These include status from all the PCB in the system aswell as control signals that are out of bounds. This includes thetemperature sensors. All of these control signals are indicated in theblock diagram as errors. The over power signal indicates that thecalculated output power exceeded 400 Watt-Seconds according to theembodiment in which 400 Watt-Seconds was the maximum power. Other powermaximums may be used in other exemplary embodiments, however. Theleakage detect signal indicates that a leakage path to ground has beendetected. The ground pad signal indicates that the ground pad isproperly connected to the electrosurgical generator. If an error orfault is detected before RF power is turned on the electrosurgicalgenerator is inhibited. If an error or fault is detected while RF poweris on, the electrosurgical generator alarms.

The electrosurgical generator can be connected to a control module suchas the CM 3000 control module manufactured by SenoRx, Inc., of AlisoViejo, Calif., via the foot switch connector. Other control modules maybe used in other exemplary embodiments. The control module can commandthe electrosurgical generator with the Cut or Coag inputs. In additionthe control logic outputs two status lines to the control module. Onestatus line is used to indicate that the electrosurgical generator haspower on and ready to deliver RF power. The other status line is used toindicate that the Cut Quality signal present and that theelectrosurgical generator has completed the start function in startmode. This signal indicates that cutting is taking place and that thecontrol module can move the cut electrode.

Referring to the Power Calculation Block Diagram of FIG. 13, theelectrosurgical generator limits the average RF output energy to 400Watt Seconds to meet the IEC requirements for an electrosurgicalgenerator, in one exemplary embodiment in which the instantaneous powercan be greater than 400 watts, and can be as much as 1200 watts. Thepower output is controlled by selecting the servo set points and dutycycle limits, and is not expected to exceed the 400 Watt Second limit.The total power output is monitored continuously to guard againstcontrol circuit failure. The circuit calculates Watt Seconds directly,avoiding any complications resulting from indirect measurements andapproximations.

The RF telemetry signals from the Patient Box are used to calculate theRF output energy as these are measured in 2 locations includingadvantageously closest to the patient connection as is most accurate.The RF telemetry from the combiner is used to monitor RF output energy.The two measurements are compared and must agree within a presettolerance or an error is generated. This comparison adds a redundantcheck on the Patient Box telemetry eliminating a potential single pointfailure causing uncontrolled RF output.

The voltage and current sensors and associated circuitry introduceunequal delays resulting in an unwanted phase shift between the voltageand current signals. A phase adjustment circuit is used to compensatefor these differences. An adjustable gain amplifier is used tocompensate for circuit component variations and make use of the fulldynamic range of the analog multiplier increasing accuracy.

The output of the analog multiplier is the product of the voltage andcurrent (Watts) which is integrated over time to calculate Watt Seconds.The exemplary integration period may be 1 millisecond after which theintegrated value is digitized the analog to digital converter (ADC).After the ADC conversion the integrator is reset to zero ready for thenext integration cycle. While one integrator is being digitized andreset a second integrator is performing an integration cycle. The outputof the analog multiplier is “ping ponged” between two integrators toperform continuous integration.

The digitized result of the 1-millisecond integration is digitallyaccumulated over a 1 second interval to complete the Watt Secondcalculation. If the digital sum exceed 400 watt seconds an “over powererror” is generated. In actuality the limit value is slightly less than400 watt seconds to account for inaccuracies the calculation process,and the 1-millisecond sample interval.

The digitized integration value is also stored in a FIFO (first in firstout) memory. One second old values are read out of the memory andsubtracted from the accumulator before a new value is added in. Thus theaccumulator is the sum of the integration values over the most recentone second period. No subtractions occur during the first one second ofoperation to initialize the FIFO memory. The power calculation circuitryruns continuously even when RF power is off. This avoids having toreinitialize the accumulator and FIFO memory.

Now referring to the Telemetry Block Diagram of FIG. 14, the telemetryfor servo control and leakage current mitigation is taken from thePatient Box. The block diagram omits the common mode chokes and leakagedrive for clarity. The main transformer is used to step up the RFvoltage. This transformer is tapped symmetrically around the center ofthe secondary winding to provide a voltage proportional to the outputvoltage. This method is used rather than measuring the output voltagedirectly because it is a low impedance connection that is not easilyunbalanced. The tapped voltage is further reduced by an isolationtransformer before providing the final voltage output.

The leakage current monitoring circuit looks for an induced common modecurrent. Two current transformers are used to monitor the common modecurrent and provide isolation and balanced drive. Since this is a safetyrelated feature two transformers are used to provide redundantmeasurement. The RF output current is monitored by a single currenttransformer. This transformer provides isolations and balanced drive forthe telemetry signal.

Cut Quality is an essentially DC voltage produce at the cuttingelectrode. It is monitored before the isolation capacitors by adifferential amplifier. The RF signal is removed with a low pass filterleaving only the Cut Quality signal. The filter output is used to drivean optically isolated amplifier that provides differential drive for thetelemetry output signal.

Referring to the Tissue Match Block Diagram of FIG. 15, the tissuematching PCB is connected between the combiner PCB and theelectrosurgical generator output to the Patient Box. In the presentconfiguration the tissue match circuit includes two relays that are usedto switch between straight pass through, and a single matching network.The matching network is only used in conjunction with start mode, andthe relays are enabled by the control logic.

The output impedance of the Patient Box is 450 based on the outputtransformer. The 450 Ohm value is not selected to best match the tissue,but to give the most flexibility when used with the Class D amplifiersand the 100 Ohm balanced feed line. The tissue impedance is differentwhen cutting than when starting, and has a lot of variation in bothcases. The single matching network is selected to match the midpoint inthe expected spread of start impedances.

Additional signals are brought out to the tissue matching circuit forpossible future enhancements. These are the telemetry signals whichinclude the voltage, current, and related phase angle. Both the voltageand current measured at the Patient Box, and at the combiner PCB areavailable. The telemetry can be monitored during a test RF pulse made atthe beginning of start mode, while the relays are still in pass throughmode. The acquire signal is to indicate when the RF test pulse isstable. Additional circuitry may be used to analyze the telemetry andselect the best match from several matching networks. A closer matchwould allow more power transfer to the tissue and better starting.

Even in the exemplary embodiment with a single matching network, theelectrosurgical generator still outputs the RF test pulse and acquiressignals. Any future change to allow the selection of more than onematching network would only involve the Tissue Match PCB.

Referring to the Leakage Mitigation Block Diagram of FIG. 16, since theelectrosurgical generator is an RF device, two kinds of leakage currentare a concern: low frequency mains currents and high frequency RFcurrents. The low frequency currents are mitigated with a mainsisolation transformer and are not illustrated in the block diagram ofFIG. 16. RF leakage current arises from unintended coupling of the RFoutput to ground. This coupling can be of any form, but the hardest tocontrol are radiated and capacitive coupling.

The first step in militating against leakage current is to isolate theRF signal path from earth ground. This is accomplished in theelectrosurgical generator by placing the active RF circuits on aninsulated sub-chassis. The main leakage path to ground inside theelectrosurgical generator is capacitive coupling. The RF circuits aremade as symmetrical as possible. This forces the capacitive coupling tobe symmetrical around earth ground causing the positive and negativehalves of the RF signal to cancel out resulting in no net leakagecurrent.

The inputs to the combiner are the two single ended RF amplifieroutputs. These signals are single ended as the return current is carriedthrough signal ground. The output of the combiner is a transformer witha balanced output. The input transformer of the Patient Box is also atransformer with a balanced input. Since the output is not groundreferenced in any way, the RF output is naturally forced to shift untilboth of the RF output signals are symmetrical about earth ground. Sincethe signals are symmetrical around ground any leakage current iscanceled. The receiving transformer only passes the intendeddifferential signal and does not pass any common mode signal. Leakagecurrent is for the most part a common mode current. The only mechanismfor coupling common modes signals is primary to secondary capacitivecoupling. The RF power transformers are fabricated with the primary andsecondary windings wound in opposite directions (not parallel) tominimize capacitive coupling.

To preserve the balance output of the electrosurgical generatorconnection to the Patient Box, a 100 Ohm shielded, balance transmissionline is used in the illustrated, exemplary embodiment. The shield isconnected to earth ground inside the electrosurgical generator. Thistransmission line is constructed such that both signal lines haveidentical capacitive coupling to ground. Again the symmetrical couplingcancels any leakage current. The Patient Box is shielded and connectedto the shield of the transmission line and thus connected to earthground. The circuits inside the Patient Box are made substantiallysymmetrical creating equal coupling to ground, thus minimizing leakagecurrents.

Any asymmetry in the RF output presents itself by as a common modesignal. The common mode choke inside the Patient Box blocks the flow ofany common mode signal. This drives the leakage current to almost zeroat the output of the patient box. The return path for leakage currentthrough the Patient Box would also be common mode. The common mode chokealso blocks this current path.

The Patient Box is not fully symmetrical in that it has two returnelectrode connections. These connections are used to verify the properattachment of the return electrode. When in use these connections are atthe same potential and can be electrically treated as a single wire.However, three physical wires must pass through the common mode choke.Proper fabrication of the choke is useful as parasitic inductance andcapacitance can be introduced in the differential (intended) signal pathif fabricated improperly. The common mode signal path must be asinductive as possible. Introducing parasitic elements in the RF signalpath can cause an impedance mismatch resulting in reduced power output.The common mode choke is advantageously fabricated use two ribbon cableferrite cores in one embodiment, allowing the conductor winding to bespread out uniformly reducing parasitic capacitance. The two returnelectrode wires are twisted together using 26 gauge wire and insultedwith #18 Teflon sleeving. The output wire is 22 gauge and insulted with#20 Teflon sleeving. These values and material types are exemplary only.The three conductors are wound on the ferrite cores as if they were twoconductors. This causes the coupling between the two return wires to beuniform and act as a single conductor at RF frequencies. The windingsare parallel and evenly spaced to insure symmetry.

The RF telemetry signals between the Patient Box and the electrosurgicalgenerator can also be a leakage current path. While the construction ofthe Patient Box is as symmetrical as possible, some telemetry signals bytheir nature are not symmetrical. The RF current monitor only measuresthe current on the RF output lead. While the ground pad monitor isconnected only to the two return leads.

Most of the sensing is done before the common mode choke. This isolatesthe patient from the potential leakage path. The RF current sensor isfabricated to minimize the capacitive coupling between the RF outputlead, and the sensor transformer. Furthermore all of the RF telemetry istransformer coupled at both ends. This forces the telemetry signals tobe balanced and the leakage currents to cancel. The transformers at thereceiving end on the Analog Control board reject any common modesignals, leaving capacitive coupling across the transformers as the onlyleakage path.

FIG. 17 shows a Leakage Path Detection Block Diagram. With all of theleakage mitigation in place there is very little leakage current betweenthe Patient Box and earth ground. This situation changes when leads areconnected to the Patient Box outputs. A new leakage path may beintroduced due to radiation of RF energy from the leads. The hazardexists due to the inadvertent contact between the patient and earthground. Since the patient is directly connected to the Patient Box viathe return electrode, leakage current can be measured at the PatientBox.

The inventive system is capable of operating at a frequency of 5 MHz anddirect measurement of leakage current at the exemplary 5 MHz operationfrequency is not effective. One method of mitigating a leakage currenthazard is to determine a leakage current path. This would be anelectrical connection between the output of the Patient Box and earthground. Testing for this path is performed in the electrosurgicalgenerator by inducing a test signal and looking for current flow. Thetest signal may be a 500 KHz AC voltage induced common mode on thePatient Box RF output leads. The test signal frequency is low enough tonot be significantly attenuated by the common mode choke. Other testfrequencies may be used in other exemplary embodiments.

A reference path to ground is created in the Patient Box by connectingtwo series capacitors to earth ground from the center tap on thesecondary side of the RF transformer. Two capacitors are used toeliminate the potential for a single fault conduction creating a shortto ground. By making a connection to the center tap of the transformerthe output is still balanced.

A common mode transformer is used to induce the test signal onto the RFoutput leads. Since the test signal is equal on both leads none of thetest signal current flows through the patient connected to the outputleads. Two current sense transformers may be used to monitor for thepresence of a common mode current indicating a leakage path. Sinceleakage detection is part of a safety system redundant measurement isrequired to eliminate the possibility of a single fault conditioncausing a failure of the leakage detection system.

The Analog Control PCB contains the circuitry to both drive the leakagepath detection drive transformer and monitor the output of the currenttransformers. The drive circuitry may be a class D amplifier feed by anadjustable voltage source in the exemplary embodiment. This allows thedrive level to be adjusted to compensate for circuit variations. A twostage filter is used to convert the square wave output of the class Damplifier to a sine wave. The first stage is on the Analog control PCB,and the second stage is in the Patient Box. The first stage low passfilters and helps match the output impedance of the amplifier to thetransmission line. The second stage continues the filtering process andblocks any of the 5 MHz RF output induced in the common transformer.This eliminates another potential leakage path.

The output of the current transformers is rectified and detectedconverting the exemplary 500 KHz telemetry signal to a DC levelproportional to the leakage current. Due to parasitic leakage paths inthe Patient Box some small amount of leakage current is always detectedwhen the drive signal is on. This low level signal is used by the AnalogControl PCB to determine that the leakage path circuit is functioningproperly. The drive signal and both current monitor circuits must befunctioning for RF output to be enabled. If the leakage currentincreases beyond a setpoint while RF is on an alarm is generated and RFpower is turned off.

The preceding merely illustrates the principles of the invention. Itwill thus be appreciated that those skilled in the art will be able todevise various arrangements which, although not explicitly described orshown herein, embody the principles of the invention and are includedwithin its spirit and scope. Furthermore, all examples and conditionallanguage recited herein are principally intended expressly to be onlyfor pedagogical purposes and to aid in understanding the principles ofthe invention and the concepts contributed by the inventors tofurthering the art, and are to be construed as being without limitationto such specifically recited examples and conditions. Moreover, allstatements herein reciting principles, aspects, and embodiments of theinvention, as well as specific examples thereof, are intended toencompass both structural and functional equivalents thereof.Additionally, it is intended that such equivalents include bothcurrently known equivalents and equivalents developed in the future,i.e., any elements developed that perform the same function, regardlessof structure.

This description of the exemplary embodiments is intended to be read inconnection with the figures of the accompanying drawing, which are to beconsidered part of the entire written description. In the description,relative terms such as lower, upper, horizontal, vertical, above, below,up, down, top and bottom as well as derivatives thereof (e.g.,horizontally, downwardly, upwardly, etc.) should be construed to referto the orientation as then described or as shown in the drawing underdiscussion. These relative terms are for convenience of description anddo not require that the apparatus be constructed or operated in aparticular orientation. Terms concerning attachments, coupling and thelike, such as connected and interconnected, refer to a relationshipwherein structures are secured or attached to one another eitherdirectly or indirectly through intervening structures, as well as bothmovable or rigid attachments or relationships, unless expresslydescribed otherwise.

Although the invention has been described in terms of exemplaryembodiments, it is not limited thereto. Rather, the appended claimsshould be construed broadly, to include other variants and embodimentsof the invention, which may be made by those skilled in the art withoutdeparting from the scope and range of equivalents of the invention.

What is claimed is:
 1. A medical device comprising: an electrosurgicaltissue cutting electrode; a return electrode; a patient box electricallyconnected to the electrosurgical tissue cutting electrode; an RFtransformer in the patient box, the RF transformer being configured tomeasure a first stream of RF telemetry signals; an RF electrosurgicalgenerator electrically coupled to the electrosurgical tissue cuttingelectrode and the return electrode, the RF electrosurgical generatorbeing configured to provide an RF signal, wherein the RF electrosurgicalgenerator being configured to measure a second stream of RF telemetrysignals at an RF combiner housed within the RF electrosurgicalgenerator, and wherein the RF electrosurgical generator being configuredto provide a start mode with a first RF power output and a first RF dutycycle and a run mode with a second RF power output and a second RF dutycycle, wherein each of the first RF duty cycle and the second RF dutycycle is a ratio of a pulse duration to a pulse period; a shieldedtransmission line electrically connecting the RF electrosurgicalgenerator to the RF transformer in the patient box, whereby the patientbox being configured to receive the RF signal from the RFelectrosurgical generator and the patient box being configured to supplyeach of the first RF power output and the second RF power output to theelectrosurgical tissue cutting electrode; a determining deviceconfigured to determine when the electrosurgical tissue cuttingelectrode has started cutting a tissue; and a control device configuredto switch the RF electrosurgical generator from the start mode to therun mode in response to the determining device when the electrosurgicaltissue cutting electrode has started to cut the tissue.
 2. The medicaldevice of claim 1, wherein the start mode is controlled by the RFelectrosurgical generator via a matching unit and includes the first RFpower output and the first RF duty cycle, and the run mode is controlledby the RF electrosurgical generator via a servo system and having thesecond RF duty cycle and the second RF power output.
 3. The medicaldevice of claim 1, wherein the determining device is configured tomonitor electrical characteristics between the electrosurgical tissuecutting electrode and tissue that is in contact with the returnelectrode, the electrical characteristics monitored include a DC voltagethat appears across the electrosurgical tissue cutting electrode and thereturn electrode as a result of plasma forming on the electrosurgicaltissue cutting electrode.
 4. The medical device of claim 3, wherein theRF electrosurgical generator is configured to operate in the start modewhen the DC voltage is less than a predetermined limit that designatestissue cutting and operates in the run mode when the DC voltage is at orexceeds the predetermined limit that designates tissue cutting.
 5. Themedical device of claim 4, wherein the RF electrosurgical generatorfurther comprises a servo system being configured such that a DC voltagelevel of the DC voltage is established to ensure that plasma has formedon the electrosurgical tissue cutting electrode.
 6. The medical deviceof claim 4, wherein the DC voltage between the electrosurgical tissuecutting electrode and an adjacent tissue exceeds the predeterminedlimit, wherein the predetermined limit is associated with a formation ofplasma at a location between the electrosurgical tissue cuttingelectrode and the adjacent tissue.
 7. The medical device of claim 4,wherein in the start mode the DC voltage is less than the predeterminedlimit, and in the run mode the DC voltage is at or exceeds thepredetermined limit.
 8. The medical device of claim 1, wherein thepatient box is configured to calculate an actual RF output energy fromthe first stream of RF telemetry signals, and the RF electrosurgicalgenerator is configured to compare the actual RF output energy from thepatient box with an RF combiner RF output energy determined from thesecond stream of RF telemetry signals; wherein the RF electrosurgicalgenerator is configured to generate an error when the actual RF outputenergy does not match the RF combiner RF output energy.
 9. The medicaldevice of claim 1, wherein the RF electrosurgical generator furthercomprises: an RF amplifier; and an RF combiner, wherein the RF amplifieris electronically coupled to the RF combiner, wherein the RF combiner isconfigured to receive the second stream of RF telemetry signals.
 10. Themedical device of claim 1, wherein the first RF duty cycle is 50 to 100%and wherein the second RF duty cycle is 15 to 40%.